Reader question:

I’m about to start my own business. What do I need to know about health insurance?

Abigail

Great question.

Having self employed health insurance is more important than even having health insurance while you are employed by a company. Consider the fact that all of your health insurance is funded by yourself, and if you don’t have it, should something happen to you that puts you in the hospital for a few days, you’ll be out of work. And if you’re self employed, you don’t get paid for things like sick days and vacation time, so not only will you have a huge hospital bill, but you will also be out several days of work with no recompense.

Getting health insurance if you are self employed is financially responsible even if nothing happens to you medically while you have it. The self employed are allowed to claim their health insurance costs on their tax returns as a business expense. For self employed people looking for a good health insurance plan, there are health savings account, which are tailored specifically for the self employed.

If you intend to be self employed, you need to find out what you will do about health insurance before leaving the job you’re at now. Looking for health insurance if you happen to have a pre existing condition, or your family does, can be difficult, and you might have to end up getting insured through your state’s high risk pool, which can be costly.

You might want to save costs and guard your personal information by not employing a health insurance broker. This is understandable, but if you choose to go this route, you will need to put much more effort and research into your search. You will need to understand the different terms and policy speak that come along with health insurance plans so that you can be sure that the plan will cover you and your family. Or you could choose to go with a broker. They cost, but they also know more about you, although they tend to be pushy.

As mentioned before, a good plan for the self employed is a health savings account. These are trusts with a bank or credit union which are tax exempt and are paid into by you, in the form of cash. In order to work, they have to come side by side with a health insurance plan with a high deductible. It gives you greater coverage than your average plan.

Cheers,

Fashun Guadarrama.

Randall Jackson, Sr., of Lexington, Kentucky, owns a small car repair shop with only three workers other than himself. They work well and hard, but Jackson is unable to give them the one thing that he believes is necessary for an employer to provide for his employees–health insurance. He has worked side by side with these good men and see them go through struggles with their health and that of their families, but as not been able to offer a helping hand because the price of health insurance is so high that he, in his small business, cannot afford to provide it. Not even for just three employees.

This situation is a big one concerning Lexington health insurance. It is required by law that companies with more than fifty employees provide health insurance plan options to its employees, but that leaves smaller companies with fewer employees high and dry. These companies are able to slide under the law without insurance, even if they can afford it, but for the most part small companies in Lexington are unable to provide health insurance coverage to their employees because it is too much cost in addition to the payroll. These small businesses already have enough trouble keeping ahead with a proft. Adding health insurance coverage would diminish that profit by quite a bit.

The state of Kentucky has come up with a solution, though, and although they are only trying it out at the moment, it will probably do a lot of good to help small companies and their employees with health insurance in the future. Called ICARE, which stands for Insurance Coverage Affordability and Relief to Employers, this jump start program is intended for providing small businesses with enough money to insure their employees. Passed by the state legislature in early 2007, the program will provide small businesses with forty dollars per employee, which will go towards their health insurance coverage. This forty dollar per person sum is given for each month, and if a certain employee is high risk or has a pre existing condition, then they are provided with extra for him or her.

Cheers,

Fashun Guadarrama.

One of the troubles with getting health insurance through your employer in many states has to do with the fact that only you yourself gets covered. Where, then, does that leave your family? This can lead to a cause of stress in many families, especially when one spouse has a job that provides medical health insurance, and another spouse has a job that does not, and neither have the money to purchase non-employer provided health insurance.

Luckily, in New York health insurance, any group health insurance plans that you get through your place of work has to cover more than just yourself–it has to cover your whole family. So if you have NY health insurance with your employer, your spouse and children must be covered as well. It also helps that if you or anyone in your family have a pre-existing condition, they are still entitled to get NY health insurance and can’t get turned down. Even if you are part of a smaller company, you don’t have to worry about your medical health insurance plan getting canceled just because one of the employees has to make a claim.

Cheers,

Fashun Guadarrama.

Working for a small business or being self employed in New York used to mean the difference between whether you were or were not covered by a NY health insurance plan. Unlike large companies, which are able to afford to provide health insurance to their many employs, self employed people and small businesses struggle to do the same while still keeping their heads above the water. Recent legislation in New York concerning NY health insurance, though, has reformed practices and may help New Yorkers out with small business group health insurance and self employed health insurance.

It may not do much good for the self-employed who only employ themsevles, but for any business that has two or more employees, they are able to take out a group health insurance plan in the state of New York. Unlike many states, though, one of the good things about this is that you don’t have to make every employee get the health insurance–it’s elective. Therefore they can choose not to get it, and small businesses will have to pay out a lot less.

Cheers,

Fashun Guadarrama.

Reader question:

What is PPO medical health insurance?

Jose

Great question.

PPO medical health insurance, also known as preferred provider organization, is one of the strictest forms of medical health insurance plans out there. The other options are the traditional indemnity health insurance plan, which is most flexible; the HMO health insurance plan, which is stricter but not very much; and the POS medical health insurance plan, which is a mixture of the two that ends up being somewhere in between. Standing by itself on a different part of the stage is the PPO medical health insurance plan, which has similarities to the other three, but is all its own.

The very good thing about PPO medical health insurance is that it is cheap. That is the thing that keeps the people it insures within its plan. The cheap premiums and decent co-payments convince people to stay within the network and continue receiving their health care insurance through the PPO medical health insurance plan.

The Good:

• The co-payments are very, very cheap. And I mean very. If you just go for a regular check up, you’re probably going to end up paying your doctor a co-payment of no more than ten little dollars.
• You don’t have to get a referral to go see a specialist. That isn’t an open ended invitation, though. In order to be covered by the policy when go to said specialist, he has to be a part of the PPO network.

The Bad:

• You can go outside of the network to see a different physician, but the coverage doesn’t extend quite as much, and you’ll have to pay for the visit at the time and then send in a health insurance claim to be reimbursed once you get the bill.
• If you do go outside the network, that’s where the deductible comes in. You’ll probably have to pay one, and it’s also true that if the physician that you visit costs more than the ones within the network, you won’t be reimbursed for the difference.

Cheers,

Fashun Guadarrama.

Reader question:

What is point of service medical health insurance?

Maggie

Great question.

A point of service medical health insurance program is kind of like a mix of both traditional indemnity insurance and health maintenance organization insurance. It has some of the qualities and cons of both, and while it has some of the flexibility of the traditional indemnity plan, it also contains the requirement of the HMO plan that you must pick a primary care provider and go only to them without a very good excuse. It’s like being both free yet organized if you pick a point of service medical health insurance plan.

If you have a point of service medical health insurance plan, then you have to choose your primary health care provider and hospital from a network chosen by the health insurance company. This isn’t a strict arrangement. If you go to a physician or hospital within the network, then you will be covered or have to make a co-payment in order to be treated for your sickness or injured part. But there is also the option of choosing a physician or hospital outside of the network to go to. If you do this, you must then file a claim with your POS.

The Good:

• Most of the point of service medical health insurance plan allow you to receive your health care outside of the network that they provide. This sounds nice and flexible at first, but it has its drawbacks. While you can get good coverage within the network, it drastically decreases once you move outside of it.
• Point of service health insurance plans are very good on things like preventive medicine and services. Not only are you covered for things like pap smears, but you even get things like cheaper rates for gyms and classes to help quit smoking.

The Bad:

• Like in an HMO, point of service medical health insurance plans require that you choose a primary health care provider, and you are then required to use that provider if you want the best rates.
• Yes, you are allowed to go outside of the network to see a doctor or specialist, but that doesn’t mean that it will be easy to get covered. If you do it without a referral from your primary health care provider, then you have to send in the bills all by yourself and might not get a check back at all, and if you do it will be a small one.

Cheers,

Fashun Guadarrama.

Reader question:

What is HMO medical health insurance?

Miriam

I’ll tell you.

The main benefit of getting an HMO, or health maintenance organization medical health insurance plan, is that this most popular of employer provided health insurance plans also tends to be the cheapest medical health insurance plan. It’s more designed for group health insurance, which is why it finds such popularity among companies insuring their employees. HMO medical health insurance is also one of the few health insurance plans that puts a lot of emphasis on preventive care.

The reason they put so much emphasis on preventive care is because, the way HMO sees it, is that preventive care can help reduce risks in an insurance pool by decreasing the likelihood that its members will develop a medical conditions, and thus it reduces medical costs. That is why it is the best to help someone stay healthy, not just to help them out if something goes terribly wrong.

The Good:

• The main thing is preventive care, which lowers both their costs and yours. HMOs also require less paperwork, and when you make a co-payment on something it will cost far less than it would with another medical health insurance plan.
• The insured under a health maintenance organization just pay a little fee each time they go to the doctor, and that is considered their co-payment.
• The coverage goes wide, with such things as outpatient services, extended medical treatment, short term mental health treatment, hospital stays, and emergency room visits.

The Bad:

• Picking and choosing the physician that you go to isn’t as easy as with traditional indemnity. Instead, you are only able to pick one provider, and that is who you must go to once he is listed on your insurance.
• The doctor you must pick has to be within the HMOs network. If you go to a hospital or physician outside of the network, then you won’t be covered at all.
• If you want to go outside of the network to see a specialist and still be covered, then you have to have a referral from your primary care provider.

Cheers,

Fashun Guadarrama.

Reader question:

How much does individual medical health insurance tend to cost, and what affects those rates?

Mandy

Good question.

There are many states who mandate that individual health insurance companies insure anybody who wants to be insured and can pay, but this isn’t true everywhere, and there also isn’t a set amount of what you will be paying. Most of the time, it will be a lot. Individual medical health insurance is very pricey, and it all depends on who you are, what your history is, and where you are at. Group plans are a lot cheaper because the number of people dilutes the risks of others in the group and it ends up averaging out, whereas for individual health insurance it’s always concentrated in one person.

An individual medical health insurance plan is usually underwritten so the health insurance company can judge your rates based on your medical history. There are a lot of things that can affect your rates in the end, even things that you wouldn’t think would affect it, such as having been pregnant at some point. Those things can be the difference between high prices and middling ones, being insured and being uninsured.

Individual medical health insurance coverage comes with much the same coverage as group medical health insurance coverage, except for the requirement of individual coverage that it be underwritten. Here are some factors considered by the underwriter:

• Age. If you’re over the age of sixty five, you might be out of luck when it comes to getting medical health insurance. Age is a big factor in who is or is nor eligible for medical health insurance.
• Sex. Benefits of your gender depend on how old you are. When people are longer, females tend to get injured more often and file more health insurance claims than males. Once they turn sixty, it’s vice verce.
• Health History and Physical Condition. Things like pre-existing conditions can make it hard to get decent medical health insuranc coverage. You might luck out and be able to get a different, more limited kind of coverage, but it’s often the case that you will be denied coverage completely.
• Job and Hobbies. What you do in your work and spare time may be more dangerous than what other people do and could result in higher rates or denial of coverage. If you like sky diving or work in construction, you might have trouble getting decent medical health insurance rates.

Cheers,

Fashun Guadarrama.

Reader question:

Who can get temporary health insurance?

Mark

Great question.

One of the reasons that short term health insurance is able to offer its policies at such low monthly prices is because it has much stricter limits on who can be covered under one of its medical health insurance plans. It creates a stricter requirement, and thus those that purchase a short term health insurance plan are part of a pool that has less risk, and with less risk come fewer health insurance claims, and with fewer health insurance claims come cheaper rates.

Usually you can’t get short term health insurance if you are over the age of sixty five. More problems that are similar to the amount of pre-existing conditions come with older age, so short term health insurance companies don’t want to cover people who have the higher risk of getting sick or injured more often. It’s also true that if you applied for a health insurance policy before and were denied, you might not be able to get a temporary health insurance policy.

If you already have a health insurance policy that covers you, even if it’s coverage is very limited, you probably won’t be able to get short term health insurance to pick up the slack. Temporary health insurance plans have several requirements, and you’ll probably have to be within a certain height and weight range in order to qualify. It’s also true that there are several questions that you will be asked about your health history that you will have to answer correctly in order to be allowed to take out a short term health insurance policy.

Cheers,

Fashun Guadarrama.

Reader question:

How much does temporary health insurance cost?

Jack

Great question.

The main reason that a lot of people choose to take out a short term health insurance policy is because it is so cheap. The reason it so cheap is because, well, it is short term and its coverage is limited. It does not cover things like pre-existing conditions and preventive care, so they tend to take on people who do not need those things and that lowers the premium payments for everyone. Most people, then, who have temporary health insurance are healthy and loyal as they only have to have the policy for twelve months. That’s a pretty risk free insured group, and without risk and with very few health insurance claims, costs are less.

If you are married and have two kids and live in Chicago, for example, let’s look at your case. You could be paying as little as three hundred dollars every month for the whole family to get one million dollars of temporary health insurance coverage with a one thousand dollar deductible. If you don’t make any claims, you’ll probably be able to renew your plan for three years until you find a long term health insurance coverage.

If you’re just a single guy and want the same thing, you’re looking at a mere seventy bucks a month.

Where the cost really comes in, though, is when you need to file a health insurance claim on your short term health insurance plan. If you have a one thousand dollar deductible, then your 100% coverage probably won’t kick in until five thousand dollars, and before that you will be co-paying.

A lot of companies that offer short term health insurance plans give you the option to pay either all at once or by month. If you pay all at once, you can get a discount.

Cheers,

Fashun Guadarrama.